Disease

Trimester

Incidence

Signs and symptoms

Laboratory findings

Complications

Pre-eclampsia and eclampsia

2nd or 3rd;

5% to 10%

Nausea; vomiting; epigastric pain; edema; hypertension; mental status changes; jaundice (late presentation)

ALT < 500 U/L, proteinuria, DIC (7%)

Maternal: Hypertensive crisis; renal impairment hepatic rupture/infarct; neurological (seizures, cerebrovascular disease)

Fetal: Abruptio placentae; prematurity; IUGR leading to increased perinatal morbidity and mortality

HELLP syndrome

3rd

0.10% (4% to 12% of women with pre-eclampsia)

Symptoms of pre-eclampsia (hypertension, headache, blurred vision); epigastric or right upper quadrant pain; nausea; vomiting; hematuria; jaundice (late presentation)

Hemolysis, ALT < 500 U/L, platelets < 100 × 10⁹/L, elevated LDH, DIC (20% - 40%)

Maternal: Seizures; acute renal f ailure; hepatic rupture, hematoma or infarct; increased mortality (1% to 3%)

Fetal: Abruptio placentae; increased mortality (35%)

Acute fatty liver of pregnancy

3^rd (can occur during 2nd)

0.01%

Malaise; upper abdominal pain; nausea; vomiting; jaundice (very common); encephalopathy (late presentation)

ALT < 500 U/L; hyperbilirubinemia; hypoglycemia; elevated ammonia; leukocytosis; DIC (>75%)―thrombocytopenia; prolonged PT,

hypofibrinogenemia

Maternal: Acute renal failure; ascites; encephalopathy; sepsis; wound seroma; pancreatitis; increased mortality

Fetal: Increased mortality (13% to 18%) from asphyxia; prematurity; IUGR; LCHAD deficiency and its complications

Viral hepatitis

Any

Same as general population

Nausea; vomiting; fever

ALT greatly elevated (>500 U/L); elevated bilirubin; positive serology tests

Maternal: Increased mortality with hepatitis E

Intrahepatic cholestasis of pregnancy

2nd or 3rd

0.1% to 0.2%

Intense pruritus; jaundice; (20% to 60%, 1 to 4 weeks after pruritus); steatorrhea

ALT < 500 U/L; markedly elevated ALP and GGT; increased bile acids; bilirubin (<10³ μmol/L)

Maternal: Predisposed to cholestasis on subsequent pregnancies

Fetal: Still birth; prematurity; fetal mortality (3.5%)

Drug-induced hepatitis

Any;

Unknown

Usually none; nausea; vomiting; pruritis jaundice (in cholestatic hepatitis)

Variable

Unknown